HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
REC�Y���
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
MAR 112020
PERMIT RENEWAL REQUEST ST. Lucie County, Permitting
PERMIT NUMBER: 19()S — 03-79 ADDRESS: (296q 1�l ar r au.. (-Pr
I, lobed LLC ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
O NER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLOA
COUNTY OF
WLEDGED BEFOUON
E THIS DAY OF / 20—
BY WHO IS PERSONALLY FU19�N TO ME ,OR
t
HAS PROVIDED AS IDENTIFICATION.
f , '
STATE OF FLO %CountyIw C i C-
SI NATURE OFY rPOB., KAREN S. NIELSE
State of Florida-Notary Pu is
•_ Commission # GG 207484
My Commission Expires
ii�`� June 12, 2022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $_ Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014